Organization Active NPI

River City Dermatology PLLC

  • Dermatology Physician
  • Jacksonville Beach, FL
National Provider Identifier
1124906433
Registry record updated Jan 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
RIVER CITY DERMATOLOGY PLLC
Practice address
1361 13TH Ave S Ste 140
Jacksonville Beach, FL 32250-3263
Phone
(904) 372-8031
Fax
(904) 372-6122
NPI assigned
Aug 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sima D Amin, MDNPI 1467912006
Title
Owner
Phone
(818) 282-2303

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1361 13TH Ave S Ste 140
Jacksonville Beach, FL 32250-3263

Mailing address

1361 13TH Ave S Ste 140
Jacksonville Beach, FL 32250-3263
Phone (904) 372-8031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260306003249 FL Part B Supplier - Clinic/Group Practice 2062994072 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville Beach, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2337217River City Dermatology PLLC1361 13TH Ave, Jacksonville Beach, FL 32250Provider-performed microscopyJan 19, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768953600000",
    "number": "1124906433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S STE 140",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503263",
            "telephone_number": "904-372-8031",
            "fax_number": "904-372-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 13TH AVE S STE 140",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503263",
            "telephone_number": "904-372-8031",
            "fax_number": "904-372-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-25",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A",
        "authorized_official_last_name": "AMIN",
        "authorized_official_first_name": "SIMA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-282-2303",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.